Cristen Bolan is the Editor of Applied Radiology.
The importance of integrating IT networks across the healthcare
enterprise is widely recognized in the industry, and backed by the U.S.
government in its drive for hospitals nationwide to adopt electronic
medical records (EMR).
Yet, according to recent studies, many
healthcare networks fall short in their efforts to connect disparate
clinical systems and achieve true interoperability.
clinical systems exponentially increase the amount of clinical
information that is available to drive quality improvement,” said
Deborah Bulger, Executive Director, Product Management, Health Systems
Performance Management, McKesson Provider Technologies, commenting on
the HIMSS 2011 Clinical Transformation Survey.1 “But while
data may be widely available, this study suggests that many
organizations still have a long way to go before it is accessible in a
way that facilitates analysis and rapid, sustainable performance
One important area where medical imaging is making
inroads into interoperability is in IT-enabled contrast media injectors.
Intelligent power injectors play a key role in today’s imaging
suites—standardizing imaging procedures to improve quality assurance and
patient safety. Much of this has been achieved by connecting power
injectors to hospital information systems (HIS), putting access to
clinical data right at the fingertips of radiologists and technologists.
Connectivity cuts down on errors
While there is no
single road to connectivity in medical imaging, IT-enabled contrast
media injectors are paving the way to improved quality of care.
first step to improving quality and reducing errors is interfacing the
flow of data between the scanner and the injector. While many
contrastmedia power injector systems are physically connected to the
scanner, which transfers the data directly into the injector, other
injector systems areIT-enabled, with hardware and software built into
the system. These IT-enabled models can pull the worklist and patient
data directly from the radiology information system (RIS), picture
archive and communication system (PACS), and/or the EMR.
systems that are not IT-enabled may be more susceptible to human error.
For example, each time a technologist has to set up a protocol, there is
a chance an error may be committed—an error that may then be mistakenly
stored in the injector. Another drawback to such systems is the
additional expense of subsequently installing the hardware and software
required to connect them to the scanner – an expense that can run as
high as $20,000 to $30,000.
With IT-enabled power injectors,
systems that import data directly from the RIS and EMR, all of the
protocols are set up once, and automatically populate the system for
each imaging exam.
At Brigham and Women’s Hospital (BWH), Boston,
MA, a teaching affiliate of Harvard Medical School, CT Manager Kathy
Piazzo oversees 8 computed tomography (CT) scanners at the main center, 3
at the off-site locations, and also manages 50 CT technologists. While
BWH has worked for several years with the IRiSCT Decision Support System
by Bracco Diagnostics (Bracco), integrated with Empower CTA Contrast
Injection systems, the hospital recently installed a new IT-enabled
contrast-media power injector system.
“We have many technologists
here, and it is difficult to get all of them to do the same thing; this
is a 24/7 operation ” Piazzo explained.
routinely call me or send QA feedback forms to me with contrast-related
questions in regards to the scans,” she said.
“They want to know
what the actual flow rate was, what happened to the bolus, if the
patient got sick during the injection, if there was an IV issue, etc.
the new system, all of the injection protocols are in the system, so
the radiologist can see the amount of contrast injected, the flow rate,
the scan time, and a pressure graph of the injection, which is valuable
information for them at the time of dictating the exam,” said Piazzo.
Similarly, with Medrad’s Personalized Patient Protocol Technology (P3T®), a contrast-injection software, protocols automatically populate the injectors.
put all of our standard 300 to 400 injection protocols in the injector
for each indication, for each type of exam,” said William P. Shuman, MD,
FACR, Professor, Body Imaging, Vice Chair, Director, Clinical
Radiology, in the Department of Radiology, University of Washington,
Seattle, WA. “It has a cardiac portion, a pulmonary angiography portion,
it has an abdomen CT portion, and we use it for our CT vascular
studies, CT angiograms and aortograms, as well. It can also download the
information directly into the PACS or HIS.”
connected physically to the scanner or interfaced with the EMR or
RIS/PACS, the injector systems perform the critical task of providing
patient data at the point of care—essential to quality assurance.
the HIMSS study, almost 75% of respondents said they need additional IT
resources to better report on quality measures. The inability to track
patients’ prior CT contrast reaction information can lead to the
recurrence of CT contrast reactions, resulting in decreased patient
satisfaction and safety, in addition to increased costs associated with
managing the reactions.1
The precise tracking of
patient data, such as reactions to contrast media, glomerular filtration
rate (GFR), creatinine levels, and conditions such as diabetes or heart
disease, contributes to establishing uniformity among procedures and
promoting compliance with safety standards.
Ensuring imaging exams
are reproducible is critical at the University of Washington, Seattle,
WA, where doctors regularly treat transplant patients.
“We see a
lot of patients, every 6 months, who are waiting for liver transplants,”
said Dr. Shuman. “We would like to compare their exams with as many
variables removed each time. So if we give exactly the same injection
protocol each time, that removes the rate of injection and other
variables that occur between sequential scans because we follow the
exact same injection protocol as before. It helps my consistency across
time when patients are getting multiple exams serially.”
is then recorded and downloaded via P3T as a list of numbers and as
graphs into the PACS, explained Dr. Shuman. “All I have todo is look at
one image in PACS, and I have graphs that show the injection rate vs.
time, injection pressure vs. time, and the volume injected.So I can see
exactly how the contrast was administered glancing at one image in the
PACS. Then any information I want to save over time, such as contrast
allergies, adverse reactions, adverse events can be automatically
downloaded into the appropriate place there.”
The EmpowerPlus also
ensures exams are carried out consistently from patient to patient.
This is particularly important for radiologists at BWH, where oncology
patients make up a sizeable portion of their population. “Injection
protocols are now standardized throughout the department so, for
example, all renal mass exams will have the same flow rate. If the
technologist changes it, they will need to document why,”said Piazzo.
protocols can also be customized to the patients’ changing needs as
they undergo treatment. By leveraging unique patient data, Dr. Shuman
specifically designs injections and image acquisitions for each patient.
P3T’s injector-based algorithms are programmed to tailor each patient’s
contrast protocol, accounting for a range of variables, including body
weight, study type, and speed of the scanner and type of contrast.
enables us to tailor the way we give contrast to individual patients
based not only on the injection rate but also on the cardiac output of
the individual patient. We believe that gives us optimal enhancement
with less contrast than untailored standardized approaches,” said
Safe and personalized care
among patients also adds to safety. With technology that tracks adverse
events, such as extravasations and allergic reactions, doctors can
customize care to each patient’s needs and ensure a higher level of
Both the IRiSCT and EmpowerMR systems track extravasations
with the Extravasation Detection Accessory (EDA). The EDA measures
electrical variances in the skin surface that can occur when contrast is
accidentally injected into the soft tissue, and it can automatically
pause the injection before tissue damage occurs. Piazzo, who has used
the extravasation tracking system in a different hospital, said it is a
great help in preventing extravasations.
Medrad offers the XDS
extravasation detector, available as an accessory that integrates with
the Stellant CT Injection System. Using radiofrequency (RF) wave
technology and a physical property called permittivity, XDS is designed
to detect the start of an extravasation under the patient’s skin and
signal the Stellant to stop injecting until a clinician can examine the
“For safety, the great thing about it is if anything goes
wrong, you have a very precise record of exactly what happened. Did we
hit our injector pressure, for example, or did we have an extravasation,
and can we see that based on the pressure or rate curve?” said Dr.
Shuman. “It’s almost like the black box on the airplane—if anything
goes wrong, you have got a record of everything that happened prior to
any event. That really helps us track causes of events as they occur.”
added, “It also helps us over time optimize our protocols. If we see a
less-than-optimal degree of contrast enhancement, we can analyze why it
was suboptimal, and see if we want to change our parameters or modify
our protocols. So the data is useful. You can use it to analyze your
safety profile or to incrementally optimize your techniques.”
unique safety feature, which also uses RF technology, applies tags to
track syringes and contrast media usage. Covidien’s Optivantage DH power
injector captures, stores, and transmits data between the RFID-enabled
syringe and the RFID-enabled power injector. TheRFID-enabled system
interfaces between the contrast media syringe and the power injector to
help technologists ensure each patient receives the prescribed
concentration and dose of contrast media. In fact, the injector can
physically alter the RFID label on a syringe once it is used—a feature
designed to reduce air injections or air embolisms caused from using an
empty, used syringe.
“All of our lot numbers, expiration dates,
the name of the contrast name, and the quantity you are using is
automatically copied on a label and printed out to go in the patient’s
medical record. You don’t have any mislabeling of the lot numbers and
expiration dates,” said Melissa Jennings, Team Leader, Radiology,
Fayette Regional Health System, Connersville, IN, where the clinical
staff conducts 400-500 CT scans a month.
Jennings added, “It’s a
lot less time consuming, allowing you to get patients in and out more
quickly.” The system also is engineered to reduce the potential for
infection from cross-contamination, by automatically preventing the
injection of contents from a previously used RFID-labeled syringe in
another patient exam.
injectors also assist in controlling costs. With features that
automatically archive injection information, such as contrast and syringe
usage, radiology departments can more effectively identify and reduce
Piazzo has relied on the IRiSCT system to generate monthly
reports on contrast and syringes, as well as to process the fiscal
budget for the following year.
“When I came to this hospital they
were using 300 contrast concentration and they wanted to switch over
370,” Piazzo recalled. “The IRiS data provided me with valuable
information needed to calculate what the cost savings would be, which
included the amount of contrast filled into syringes, the amount of
contrast injected, and the amount of contrast wasted. So knowing what
the current cost of the contrast was, I could calculate the total cost
savings. I think we ended up saving close to $27,000 in contrast media
based on the IRiS information we had.”
With integrated IT
solutions, power injector systems help to make exams more consistent,
improve quality, ensure greater safety, and save money. As the adoption
of IT-enabled contrast media power injectors becomes more prevalent,
these devices have the potential to become a central data hub,
orchestrating all procedures in the imaging suite—from patient check-in
to patient check-out.
- Organizations embrace clinical improvement but require tools for
data analysis. HIMSS 2011 Clinical Transformation Survey. 2011
Healthcare Information and Management Systems.
Accessed June 14, 2011.